Provider Demographics
NPI:1972612737
Name:PINNELAS, IRA M (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:PINNELAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CONCORD TERRACE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2823
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-858-0404
Practice Address - Street 1:92 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:407-649-9111
Practice Address - Fax:954-858-0404
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60101208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375691200Medicaid
FL375691200Medicaid
68584ZMedicare ID - Type Unspecified